Most adults in the United States consume alcohol at least once in their lives, but for 16 million people – both adults and adolescents – drinking has led to addiction. The U.S. Centers for Disease Control and Prevention (CDC) defines excessivedrinking as:
- Binge drinking, or consuming four to five servings of alcohol in two hours
- Heavy drinking, or consuming one to two servings of alcohol per day, or between seven and fourteen servings of alcohol per week
- Alcohol use disorder, which is addiction to drinking that is signified by periods of binge and heavy drinking, along with physical dependence on alcohol, cravings for the substance, drinking more, and experiencing withdrawal when you cannot drink
Heavy drinking can lead to physical dependence, or it can be a sign that this condition has developed. Many people who just drink heavily but who are not addicted to alcohol can stop drinking safely; however, many people who struggle with alcohol use disorder (AUD), formerly called alcoholism, need specific behavioral and medical treatment to overcome this chronic illness.
For the most part, behavioral treatments like group and individual therapy during rehabilitation are the best approach to understanding, managing, and reducing symptoms of addiction, but for many people, detoxing before going into rehabilitation requires medical help. This is called medication-assisted treatment, or MAT. The process of MAT involves prescription medicines that ease withdrawal symptoms, allowing the body to slowly taper off the need to be stimulated until the brain can manage neurotransmitters on its own.
Drugs Used in Medication-Assisted Treatment (MAT) To Treat Alcohol Abuse
There are three medications approved to treat AUD in the United States: naltrexone, acamprosate, and disulfiram. There are also prescription drugs that may be used off-label to manage withdrawal symptoms associated with addiction to alcohol that involved drinking large quantities for many years. These can be prescribed by health care professionals. They may overlap with addiction counseling or be used to safely detox before you enter rehabilitation.
- Benzodiazepines: These medications are sedatives that were developed to manage anxiety; however, the drugs work in the gamma-Aminobutyric acid (GABA) brain pathways just like alcohol, so long-acting benzodiazepines like Valium (diazepam) may be prescribed off-label to treat alcohol abuse during the detox process. By triggering similar pathways, but at monitored prescription doses, benzodiazepines can help people taper off physical dependence on alcohol. The World Health Organization (WHO) recommends benzodiazepines as a front-line detox medication for AUD. These medications are some of the most studied and most effective medications at reducing the risk of severe alcohol withdrawal syndrome (AWS).
- Antiepileptic medications: Some of the most harmful risks associated with detoxing from alcohol are seizures or convulsions. These symptoms are associated with a syndrome called delirium tremens (DTs). If the risk of DTs is high, then inpatient treatment, potentially with anti-epilepsy medications like valproate, carbamazepine, and gabapentin, may be prescribed as the individual overcomes their physical dependence on alcohol.
- Naltrexone: This drug blocks the euphoric effects associated with both alcohol and opioid abuse. While taking naltrexone regularly, if you do experience a lapse and consume alcohol, you will not feel good, relaxed, or pleasantly buzzed from it; you simply won’t feel anything. Additionally, naltrexone has been reported to reduce cravings, which helps people who are overcoming AUD remain motivated in treatment, avoid relapses, and take other prescription medications as needed.It is important to note that naltrexone is not prescribed for people who are still in the process of detoxing from alcohol abuse. It works for people who have overcome their physical dependence on alcohol and need support to stay sober. Often, naltrexone is not prescribed for people who are new to detox and rehabilitation for alcohol abuse, but instead prescribed for people who have trouble staying sober and have experienced multiple relapses.
- Acamprosate: This drug is another that is prescribed primarily for people who have already stopped drinking and gone through detox. The drug does not prevent withdrawal symptoms, so those will need to be managed by medical professionals in a detox program. Instead, acamprosate relieves some of the symptoms from protracted abstinence, like cravings.
Disulfiram: This is the first medication approved to treat alcohol use disorder. While it is rarely used in modern medicine, it may still be prescribed to people who have tried other medications like acamprosate but did not experience good results. Like both acamprosate and naltrexone, disulfiram is prescribed after you have gone through detox, and it is an abstinence maintenance medication.
Rather than reducing cravings, however, disulfiram causes a serious negative reaction if you consume alcohol. You will feel nauseated, feverish, and may experience a pounding or racing heart. The side effects were presumed to cause one to associate alcohol with negative effects rather than positive ones, but these side effects have also been found to be dangerous in some people, leading to heart attacks, respiratory depression, convulsions, or death.
How Is Alcohol MAT Different from Opioid MAT?
In general terms, MAT is the use of any medication that’s specifically approved to treat a substance use disorder. However, MAT drugs that treat opioid dependence are used for the purpose of replacement. Opioid MAT drugs like methadone and buprenorphine are opioids themselves. They work in similar ways as other prescription and illicit opioids like oxycodone and heroin. If someone is dependent on an opioid, a drug like buprenorphine can help them stop using that opioid while avoiding uncomfortable withdrawal symptoms. However, MAT medications are easier to manage and have fewer intoxication side effects, allowing an opioid-dependent person to go about their everyday life and attend other treatment services.
Benzodiazepines are sometimes used for similar purposes in alcohol use disorders. Benzodiazepines work with the neurotransmitter GABA in a way that’s similar to alcohol, so they can help alleviate alcohol withdrawal and cravings. However, benzodiazepines aren’t usually used for regular long-term use. Instead, they’re typically used to help taper off of alcohol slowly.
Other alcohol MAT drugs are used as a deterrent or a drug that makes alcohol less desirable to use. Disulfiram was the first drug that was specifically used to treat alcohol use disorders. Since it makes drinking alcohol uncomfortable, the idea is that you will not want to drink alcohol while on the drug, even if you have cravings. If you do drink, the resulting discomfort may psychologically train you to associate alcohol with that discomfort. Naltrexone is also a deterrent that blocks the pleasurable effects of alcohol. While you’re taking it, there will ideally be no reason to drink.
The Drawbacks of MAT for Alcohol Use Disorders
One of the major drawbacks of MAT drugs for alcohol use disorders is the need for medication compliance. Med compliance is important in treating disease or disorder. But it may be difficult when using medications like disulfiram and naltrexone. The drugs only deter alcohol use when you take them as directed. Since these medications cause you to feel worse if you drink alcohol, people with substance use disorders may avoid taking the drug. For many, the fact that taking the drug requires willpower that you may not have when it comes to drinking makes this kind of treatment less effective. However, these medications may be used in detox and inpatient treatment, where you will have more clinical support to help encourage med compliance.
Why Is MAT Valuable to Overcome Alcohol Abuse?
The biggest reason to use any of the prescription medications above is avoiding a relapse back into drinking alcohol, especially if this problem has come up before. For people who struggle with compulsive behaviors around alcohol but have not struggled with this problem for a longer period of time, who do not drink large amounts of alcohol, or both, delirium tremens may not be a risk. People who are at risk of developing DTs are those who drink 4 pints to 5 pints (between 1 and 3 liters) of wine, 7 pints to 8 pints (3 to 4 liters) of beer, or 1 pint (half a liter) of hard alcohol like whiskey or vodka every day for several months. Additionally, people who have struggled with compulsive behaviors around alcohol for more than 10 years are at greater risk of developing DTs, as are people who have tried multiple times to quick abusing alcohol but have suffered several relapses.
For alcohol use disorder, MAT is not the first approach to detox and rehabilitation. It is typically an intervention reserved for people who struggle with severe AUD, who have a prior history of substance abuse, or who have relapsed back into alcohol abuse multiple times. However, this approach to treating AUD has an important place in the treatment process.
If you are prescribed naltrexone, acamprosate, or disulfiram, you may take these medications after you have safely detoxed with supervision and are in rehabilitation. Being able to focus on therapy to change your behaviors, with the support of medications that you know reduce your risk of relapse, can be very helpful in easing stress. Reducing the risk of seizures and helping you taper off the need for alcohol, using either antiepileptic drugs or benzodiazepines, can be very useful for those who have struggled to safely detox in the past.
Do I Need Therapy If I Get Medications?
Medication-assisted treatment for alcohol will ideally involve the use of both medications and other treatment options like therapy. But if you’re getting medications that alleviate withdrawal or deter drinking, do you really need therapy? Most of the time, therapy is necessary to address the issues associated with substance use disorders. Addiction is a chronic disease that affects the reward center of the brain and creates powerful compulsions to drink, even despite serious consequences. Psychotherapy and behavioral therapy can help address some of the underlying issues that are associated with addiction. They can also help you learn effective coping responses to cravings and develop a relapse prevention strategy. Plus, MAT drugs like acamprosate are able to help reduce the likelihood of relapse when used alongside psychosocial interventions. But it may be less effective when it’s used by itself.